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Chapter 49
Diabetes Mellitus
| Question | Answer |
|---|---|
| What is Diabetes Mellitus? | diabetes mellitus is actually a group of disorders that are characterized by high levels of blood sugar (hyperglycemia). This occurs as a result from defects in the production of insulin, how this insulin works or a combination of both factors. |
| What are the assessments/tests that are used to diagnose/identify diabetes? | A1C (glycosylated hemoglobin) Fasting Plasma Glucose ( FPG) Oral Glucose Tolerance Test (OGTT) |
| A1C Test measurements in % | Normal Range <5.7% Diabetes Range >or=6.5% Anything else in between is Pre-diabetes |
| FPG measurements in mg/dL | Normal Range <100 mg/dL Diabetes Range >or =126mg/dL Anything else in between is Pre-diabetes |
| OGTT measurements in mg/dL | Normal Range <140 mg/dL Diabetes Range >or=200mg/dL Anything else in between is Pre-diabetes |
| What is Prediabetes AKA impaired Glucose Tolerance | This is the metabolic stage between normal and diabetes. This stage, however, indicates a HIGH RISK for developing DIABETES |
| Types of Diabetes and Incidence Cause | There are 4 Types Obesity is the cause for the increase in cases in the American Population |
| Type 1 Diabetes (Abrupt Onset) | Defective insulin production Insulin injection or pump 5% of diabetic population Presence of DR3, DR4 and other leukocyte antigen creates the genetic pre-disposition for the autoimmune cause for this condition |
| Type 2 Diabetes (Slow Onset) | Insulin resistance/body cannot use insulin produced Oral and injectable medications types Respond well to/managed with weight reduction, dietary management, exercise and medications Risks: obesity, age, inactivity, hypertension, hx of GDM, dyslipidemia |
| Gestational Diabetes (GDM) | during pregnancy |
| Other Specific Types Diabetes | associated with certain conditions or syndromes such as pancreatic/endocrine diseases infections chemical/drug induced genetic defects/syndromes insulin-receptor abnormalities and other |
| Role of Hygienist's in the Care of a Person with Diabetes | Periodontal risk assessment Determine need for co-management Monitoring medications to prevent interactions with control of glucose Minimize potential emergency risk |
| Cont. Role of Hygienist..... | Detect uncontrolled and undiagnosed diabetes and refer to physician Modification of DHYG care plan based on patient's needs Evaluation of outcomes |
| Antibiotic Premedication and Diabetes | A patient with WELL-CONTROLLED diabetes WITHOUT EVIDENCE of INFECTIONS DOES NOT require prophylactic antibiotic PREMEDICATION. |
| Local anesthesia and Diabetes | Recommended LOWEST DOSE/LOWEST CONCENTRATION VASOCONSTRICTOR EPINEPHRINE=RAISES BLOOD GLUCOSE=INSULIN ANTAGONIST |
| Dental Hygiene Treatment and Measurements | NO TX IF BLOOD GLUCOSE IS: <70 mg/dL OR >200 mg/dL |
| Epinephrine, diabetes and stress | Emotional stress = release of epinephrine= alerts/activates the blood glucose to move around=hyperglycemic/diabetic ketoacidosis emotional stress can be induced in the dental setting |
| Controlled Diabetes | Well-controlled diabetes=within normal range=balance of medication/exercise/diet |
| What is the most common precipitating/rising factor of hyperglycemic ketoacidosis? | INFECTION |
| Hyperglycemic Ketoacidosis (rise in blood glucose >400mg/dL) | HOSPITALIZATION to correct fluid and electrolyte imbalance |
| Hypoglycemia (decrease blood glucose <70mg/dL) | common emergency TYPE 1 but also in TYPE 2 in patients treated with Sulfonylureas Insulin excess/glucose deficiency SIGNS/SYMPTOMS: Confusion, irritability, sweating, tachycardia shakiness, hunger |
| Long term complications Type 1 | Predominant: Kidney Eye disease Peripheral Nerve disease |
| Long term complications Type 2 | Predominant: Atherosclerosis Peripheral Nerve disease |
| What is insulin for and what occurs when not functioning? | No insulin=glucose stays in blood (hyperglycemia) Insulin is meant to be stored or used by the cells to produce energy |
| Symptoms Alert | Glucosuria=glucose in urine Polyuria= raised volume of urine Polydipsia=excessive thirst Weight Loss Polyphagia= excessive ingestion of food Blurred Vision |
| Gestational Diabetes Mellitus (GDM) | Usually disappears after birth Results from normal anti-insulin effects of pregnancy hormones and diversion of natural glucose to fetus Occurs in 4% of pregnancies |
| Who is at risk of GDM? | Women with obesity Family history Previous GDM |
| REMEMBER | Many people with diabetes DO NOT KNOW they have the disease We can make a difference by identifying risk factors in the medical history |
| Ketoacidosis Signs and Symptoms | Common: "fruity" acetone breath, frequent urination, excessive thirst, unusual hunger, weight loss, weakness, nausea, dry skin and mucous membranes, flushed facial appearance, abdominal tenderness, rapid breathing, depressed sensory perception |
| Type 1 Diabetes Warning Signs | Frequent urination unusual thirst extreme hunger unusual weight loss extreme fatigue irritability blurred vision very dry skin |
| Type 2 Diabetes Warning Signs | Any of the Type 1 signs and: Slow healing cuts and bruises Tingling/Numbness hands and feet Hard to heal or recurring skin, gingival or bladder infections |
| Types of Insulin | Rapid- Acting Short-Acting Intermediate-Acting Long-Acting Inhaled Insulin |
| Oral Medications for Diabetes Type 2 | Metformin/if not contraindicated PREFERRED medication Kidney malfunction or reduced function NO metformin Other names for metformin (Glucophage |
| More Type 2 Oral Meds | Sulfonylureas (think sulfa and urea/urine) associate frequent urine because it is a symptom of diabetes...STIMULATES PANCREAS TO SECRETE INSULIN IN TYPE 2 Other name for med is Glyburide Actos, Januvia, Precose are also meds for diabetes type 2 |
| Type 2 Injectable Meds | Byetta (think Bye Jetta) Victoza (Think Victoria) Symlin (Think Smyling) |
| Take Note | People with diabetes are also treated with other meds such as anticoagulant/antiplatelet, antihypertensive or lipid-lowering (cholesterol) because of the ramifications of the condition on the rest of the body, remember???? |
| Oral findings with poorly controlled diabetes | Cheilosis Xerostomia Increased levels of caries Glossodynia/burning mouth Enlarged salivary glands Increased glucose in saliva Candidiasis/thrush Periodontal Disease |
| Identification and Treatment of Hypoglycemia in the Dental Office | REVIEW BOX 49.13 |
| Patient or Client Education | Emphasize Diabetes = Increased Risk for Periodontitis Low tolerance for dentures Must exercise good oral homecare to help control oral disease Water Irrigation Prone to Periodontitis |
| What are the major 6 complications of diabetes? | The classic list includes: Retinopathy Nephropathy Neuropathy Macrovascular Diseases Altered Wound Healing Periodontal Disease (the AAP named this the 6th complication) |
| Why does tissue damage occurs in patient with diabetes? | Due to the altered immunoinflammatory response |
| Diabetes and Periodontal Disease | 60% people with diabetes=moderate to severe periodontal disease |
| Oral hypoglycemia medications to treat hyperglycemia | About 58% of persons with Type 2 diabetes take oral hypoglycemic medication to treat hyperglycemia |
| Most common medical emergency of people with diabetes | Hypoglycemia |
| What is a safe range of blood glucose for treatment to be rendered safely? | 80 to 149 mg/dL REFER TO BOX 49.8 |
Created by:
IBrandt
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